title: Assessing framing assumptions in quantitative health impact assessments: a housing intervention example.
abstract: Health impact assessment (HIA) is often used to determine ex ante the health impact of an environmental policy or an environmental intervention. Underpinning any HIA is the framing assumption, which defines the causal pathways mapping environmental exposures to health outcomes. The sensitivity of the HIA to the framing assumptions is often ignored. A novel method based on fuzzy cognitive map (FCM) is developed to quantify the framing assumptions in the assessment stage of a HIA, and is then applied to a housing intervention (tightening insulation) as a case-study. Framing assumptions of the case-study were identified through a literature search of Ovid Medline (1948-2011). The FCM approach was used to identify the key variables that have the most influence in a HIA. Changes in air-tightness, ventilation, indoor air quality and mould/humidity have been identified as having the most influence on health. The FCM approach is widely applicable and can be used to inform the formulation of the framing assumptions in any quantitative HIA of environmental interventions. We argue that it is necessary to explore and quantify framing assumptions prior to conducting a detailed quantitative HIA during the assessment stage.
authors.affiliation: Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK. marco.mesa-frias@lshtm.ac.uk
authors.forename: Marco
authors.initials: M
authors.lastname: Mesa-Frias
authors.forename: Zaid
authors.initials: Z
authors.lastname: Chalabi
authors.forename: Anna M
authors.initials: AM
authors.lastname: Foss
mesh_terms: D016902:Air Pollution, Indoor; D004781:Environmental Exposure; D017143:Fuzzy Logic; D062489:Health Impact Assessment; D006798:Housing / Q000592:standards*; D006801:Humans
keywords: Environmental health; Health impact assessment; Housing; Modelling; Risk assessment